"Continuity" as an organizing principle for clinical education reform.

If the ultimate purpose of medical education — to meet the health needs of society — is to be achieved, the primary goal of undergraduate medical education should be to produce students who are broadly skilled in the core competencies that transcend all disciplines of medicine.1,2 The challenge is how to accomplish this goal in a clinical learning environment fragmented by increasing specialization and demands for clinical productivity and constrained by a prevailing culture in which education must compete with research and clinical practice for medical school resources.3 As compared with the dramatic changes that have occurred in biomedical science and the practice of medicine, the fundamental model of clinical education in American medical schools has changed little since the time of Sir William Osler, a century ago. Students are still assigned to specialty-specific teams of interns, residents, and supervising faculty physicians for relatively brief, randomly sequenced rotations in acute care hospitals.4,5 And the core clinical credentialing experience continues to be this same series of rotations, primarily in the third year of the traditional four-year undergraduate curriculum, just as it was in Osler’s day. Although there is no doubt that the hospital environment remains rich in learning opportunities for medical students and that students need to learn the skills necessary to succeed in an environment in which most of them will spend 3 to 8 years of postgraduate training, there is a growing sense nationally that the current model is poorly aligned with society’s present and future health care needs.6,7 This realization has led many observers to call for a new model of clinical education, one that would incorporate the strengths of the present acute care educational model but eliminate the model’s major weakness — a lack of connection or continuity among different learning experiences.8,9